Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

FILTER LEUKOCYT PALL

Facility

OP

$96.00

Hospital Revenue Code	272
Min. Negotiated Rate	$48.96
Max. Negotiated Rate	$93.12
Rate for Payer: Cash Price	$57.60
Rate for Payer: Hawaii Western Management Group Commercial	$91.20
Rate for Payer: Health Management Network Commercial	$81.60
Rate for Payer: Kaiser Permanente Commercial	$60.48
Rate for Payer: Kaiser Permanente Medicaid	$48.96
Rate for Payer: MDX Hawaii PPO	$93.12
Rate for Payer: University Health Alliance Commercial	$69.97

FILTER PLATELTS PALL

Facility

OP

$157.00

Hospital Revenue Code	272
Min. Negotiated Rate	$80.07
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$94.20
Rate for Payer: Hawaii Western Management Group Commercial	$149.15
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: Kaiser Permanente Commercial	$98.91
Rate for Payer: Kaiser Permanente Medicaid	$80.07
Rate for Payer: MDX Hawaii PPO	$152.29
Rate for Payer: University Health Alliance Commercial	$114.44

FILTER PLATELTS PALL

Facility

IP

$157.00

Hospital Revenue Code	272
Min. Negotiated Rate	$133.45
Max. Negotiated Rate	$152.29
Rate for Payer: Cash Price	$94.20
Rate for Payer: Health Management Network Commercial	$133.45
Rate for Payer: MDX Hawaii PPO	$152.29

FINASTERIDE 5 MG TABLET [10037]

Facility

OP

$11.00

Service Code	NDC 50268031415
Hospital Revenue Code	637
Min. Negotiated Rate	$5.61
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Hawaii Western Management Group Commercial	$10.45
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: Kaiser Permanente Commercial	$6.93
Rate for Payer: Kaiser Permanente Medicaid	$5.61
Rate for Payer: MDX Hawaii PPO	$10.67
Rate for Payer: University Health Alliance Commercial	$8.02

FINASTERIDE 5 MG TABLET [10037]

Facility

IP

$4.00

Service Code	NDC 60687042865
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

FINASTERIDE 5 MG TABLET [10037]

Facility

OP

$4.00

Service Code	NDC 60687042865
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

FINASTERIDE 5 MG TABLET [10037]

Facility

IP

$4.00

Service Code	NDC 60687042801
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

FINASTERIDE 5 MG TABLET [10037]

Facility

OP

$4.00

Service Code	NDC 60687042811
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

FINASTERIDE 5 MG TABLET [10037]

Facility

IP

$11.00

Service Code	NDC 50268031415
Hospital Revenue Code	250
Min. Negotiated Rate	$9.35
Max. Negotiated Rate	$10.67
Rate for Payer: Cash Price	$6.60
Rate for Payer: Health Management Network Commercial	$9.35
Rate for Payer: MDX Hawaii PPO	$10.67

FINASTERIDE 5 MG TABLET [10037]

Facility

IP

$4.00

Service Code	NDC 60687042811
Hospital Revenue Code	250
Min. Negotiated Rate	$3.40
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: MDX Hawaii PPO	$3.88

FINASTERIDE 5 MG TABLET [10037]

Facility

OP

$4.00

Service Code	NDC 60687042801
Hospital Revenue Code	637
Min. Negotiated Rate	$2.04
Max. Negotiated Rate	$3.88
Rate for Payer: Cash Price	$2.40
Rate for Payer: Hawaii Western Management Group Commercial	$3.80
Rate for Payer: Health Management Network Commercial	$3.40
Rate for Payer: Kaiser Permanente Commercial	$2.52
Rate for Payer: Kaiser Permanente Medicaid	$2.04
Rate for Payer: MDX Hawaii PPO	$3.88
Rate for Payer: University Health Alliance Commercial	$2.92

FINELINE LEAD AV 45CM 4469

Facility

IP

$1,815.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,016.40
Max. Negotiated Rate	$1,760.55
Rate for Payer: Cash Price	$1,089.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,270.50
Rate for Payer: Health Management Network Commercial	$1,542.75
Rate for Payer: MDX Hawaii PPO	$1,760.55
Rate for Payer: University Health Alliance Commercial	$1,016.40

FINELINE LEAD AV 45CM 4469

Facility

OP

$1,815.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$925.65
Max. Negotiated Rate	$1,760.55
Rate for Payer: Cash Price	$1,089.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,270.50
Rate for Payer: Health Management Network Commercial	$1,542.75
Rate for Payer: Kaiser Permanente Commercial	$1,143.45
Rate for Payer: Kaiser Permanente Medicaid	$925.65
Rate for Payer: MDX Hawaii PPO	$1,760.55
Rate for Payer: University Health Alliance Commercial	$1,016.40

FINELINE LEAD AV 52CM 4470

Facility

OP

$1,815.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$925.65
Max. Negotiated Rate	$1,760.55
Rate for Payer: Kaiser Permanente Medicaid	$925.65
Rate for Payer: Cash Price	$1,089.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,270.50
Rate for Payer: Health Management Network Commercial	$1,542.75
Rate for Payer: Kaiser Permanente Commercial	$1,143.45
Rate for Payer: MDX Hawaii PPO	$1,760.55
Rate for Payer: University Health Alliance Commercial	$1,016.40

FINELINE LEAD AV 52CM 4470

Facility

IP

$1,815.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,016.40
Max. Negotiated Rate	$1,760.55
Rate for Payer: Cash Price	$1,089.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,270.50
Rate for Payer: Health Management Network Commercial	$1,542.75
Rate for Payer: MDX Hawaii PPO	$1,760.55
Rate for Payer: University Health Alliance Commercial	$1,016.40

FINELINE LEAD STEROX 4457

Facility

IP

$2,400.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,344.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

FINELINE LEAD STEROX 4457

Facility

OP

$2,400.00

Service Code	HCPCS C1898
Hospital Revenue Code	275
Min. Negotiated Rate	$1,224.00
Max. Negotiated Rate	$2,328.00
Rate for Payer: Cash Price	$1,440.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,680.00
Rate for Payer: Health Management Network Commercial	$2,040.00
Rate for Payer: Kaiser Permanente Commercial	$1,512.00
Rate for Payer: Kaiser Permanente Medicaid	$1,224.00
Rate for Payer: MDX Hawaii PPO	$2,328.00
Rate for Payer: University Health Alliance Commercial	$1,344.00

FINE NEEDLE ASPIRATION BIOPSY, INCLUDING ULTRASOUND GUIDANCE; FIRST LESION

Facility

OP

$2,837.00

Service Code	CPT 10005
Hospital Revenue Code	361
Min. Negotiated Rate	$340.18
Max. Negotiated Rate	$2,837.00
Rate for Payer: AlohaCare Medicaid	$836.55
Rate for Payer: AlohaCare Medicare	$836.55
Rate for Payer: Devoted Health Medicare	$920.21
Rate for Payer: Hawaii Medical Service Association ABD	$393.00
Rate for Payer: Hawaii Medical Service Association Commercial	$2,536.00
Rate for Payer: Hawaii Medical Service Association Medicare	$836.55
Rate for Payer: Hawaii Medical Service Association Non-ABD	$496.75
Rate for Payer: Humana Medicare	$836.55
Rate for Payer: Kaiser Permanente Medicaid	$2,837.00
Rate for Payer: Kaiser Permanente Medicare	$836.55
Rate for Payer: Ohana Health Plan Medicaid	$920.21
Rate for Payer: Ohana Health Plan Medicare	$836.55
Rate for Payer: UnitedHealthcare Medicaid	$340.18
Rate for Payer: UnitedHealthcare Medicare	$836.55

FIXATION DEVICE 5MM 174006

Facility

OP

$2,260.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,152.60
Max. Negotiated Rate	$2,192.20
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Hawaii Western Management Group Commercial	$2,147.00
Rate for Payer: Health Management Network Commercial	$1,921.00
Rate for Payer: Kaiser Permanente Commercial	$1,423.80
Rate for Payer: Kaiser Permanente Medicaid	$1,152.60
Rate for Payer: MDX Hawaii PPO	$2,192.20
Rate for Payer: University Health Alliance Commercial	$1,647.31

FIXATION DEVICE 5MM 174006

Facility

IP

$2,260.00

Hospital Revenue Code	272
Min. Negotiated Rate	$1,921.00
Max. Negotiated Rate	$2,192.20
Rate for Payer: Cash Price	$1,356.00
Rate for Payer: Health Management Network Commercial	$1,921.00
Rate for Payer: MDX Hawaii PPO	$2,192.20

FIXATION KIT ACL/PCL AR-1593

Facility

IP

$1,800.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,746.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,260.00
Rate for Payer: Health Management Network Commercial	$1,530.00
Rate for Payer: MDX Hawaii PPO	$1,746.00
Rate for Payer: University Health Alliance Commercial	$1,008.00

FIXATION KIT ACL/PCL AR-1593

Facility

OP

$1,800.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$918.00
Max. Negotiated Rate	$1,746.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Hawaii Western Management Group Commercial	$1,260.00
Rate for Payer: Health Management Network Commercial	$1,530.00
Rate for Payer: Kaiser Permanente Commercial	$1,134.00
Rate for Payer: Kaiser Permanente Medicaid	$918.00
Rate for Payer: MDX Hawaii PPO	$1,746.00
Rate for Payer: University Health Alliance Commercial	$1,008.00

FIXATION SECONDARY AR-1593-P

Facility

IP

$2,284.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,279.04
Max. Negotiated Rate	$2,215.48
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,598.80
Rate for Payer: Health Management Network Commercial	$1,941.40
Rate for Payer: MDX Hawaii PPO	$2,215.48
Rate for Payer: University Health Alliance Commercial	$1,279.04

FIXATION SECONDARY AR-1593-P

Facility

OP

$2,284.00

Service Code	HCPCS C1713
Hospital Revenue Code	278
Min. Negotiated Rate	$1,164.84
Max. Negotiated Rate	$2,215.48
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Hawaii Western Management Group Commercial	$1,598.80
Rate for Payer: Health Management Network Commercial	$1,941.40
Rate for Payer: Kaiser Permanente Commercial	$1,438.92
Rate for Payer: Kaiser Permanente Medicaid	$1,164.84
Rate for Payer: MDX Hawaii PPO	$2,215.48
Rate for Payer: University Health Alliance Commercial	$1,279.04

FIXATION TOOL 6616

Facility

IP

$150.00

Hospital Revenue Code	272
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$145.50
Rate for Payer: Cash Price	$90.00
Rate for Payer: Health Management Network Commercial	$127.50
Rate for Payer: MDX Hawaii PPO	$145.50

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